Abdominal Pain Assessment
Presentation with acute abdominal pain in the emergency departments (ED) requires prompt intervention by healthcare providers by conducting a quick history taking and physical assessment. Depending on the location of pain in the abdomen, the associated disorders can get identified for a differential diagnosis.
In the right upper quadrant, acute hepatitis, acute pancreatitis, cholelithiasis, duodenal ulcer, hepatomegaly, myocardial infarction, pericarditis, and pneumonia are the common differential diagnoses (DeWit, Stromberg & Dallred, 2016). Regarding the left upper left quadrant, the most common causes of abdominal pain include acute pancreatitis, duodenal ulcer, gastric ulcers, gastritis, pericarditis, splenic abscess, splenic infarct, or splenic rupture. Appendicitis, mesenteric adenitis, and Meckel’s diverticulitis are differential diagnoses distinct in the right lower quadrant (Alvarado, 2018). Diverticulitis, ectopic pregnancy, endometriosis, hernia, inflammatory bowel syndrome, renal stones, Mittelschmerz, ovarian cyst, ovarian torsion, tubo-ovarian abscess, and psoas abscess are common both in the right and left lower quadrants.
My healthcare organization has an adult protocol with a concise step-by-step process that health care providers utilize to manage abdominal pain. Following the presentation to the Emergency Department, a clinician initiates the first responder treatment to ensure the patient has a patent airway, breathes with ease, and has a perfusing pulse and starting treatment of shock where applicable. Basic life support treatment goes in handy with the first responder treatment components; Ondansetron 4mg PO is given for nausea and vomiting. Initial life support treatment follows after BLS treatment, which includes IV fluid therapy, preferably 500ml fluid bolus if the patient is hypotensive to achieve a systolic blood pressure of at least 100mmHg. Advanced life support is then initiated, and transportation for further management, such as for laparoscopy or CT scan, is essential. Morphine sulfate 2-5mg IV every 5 minutes is given to relieve the patient’s pain and anxiety. The same dosage is given intramuscularly if unable to establish IV access. Allergy to morphine prompts administration of Fentanyl 500mcg for 2 minutes for pain management. The patient undergoes monitoring for further management.
References
Alvarado, A. (2018). Clinical Approach in the Diagnosis of Acute Appendicitis. In Current Issues in the Diagnostics and Treatment of Acute Appendicitis. IntechOpen
DeWit, S. C., Stromberg, H., & Dallred, C. (2016). Medical-surgical nursing: Concepts & practice. Elsevier Health Sciences.